Forum Center: States’ drug abuse?

By Alex Culpepper

Illustration: Bruce Plante

It takes an average of 12 years for a drug to make it from a laboratory to your medicine cabinet. Yet, it took states like Ohio and Oklahoma less than a year to come up with a new drug cocktail for the purpose of executing convicted criminals sentenced to die for their crimes. They needed those new drugs because European and domestic suppliers have discontinued serving up the traditional lethal chemicals executioners depended on for so many years.

In January of this year, an Ohio death-row inmate was executed via the new cocktail. However, questions formed about its efficacy of maintaining our constitution’s Eighth Amendment right against cruel and unusual punishment because, according to witnesses, the execution of Dennis McGuire appeared to involve abnormal pain, distress and anxiety. After reviewing McGuire’s postmortem medical records, coupled with conversations with “experts,” officials for the State of Ohio concluded, “there is no evidence McGuire experienced any pain, distress or anxiety” during his record-breaking 20-minute execution last January.

Last week in Oklahoma, an even more controversial incident occurred with the new drug combinations used for execution. In this case, the administering of the drugs appears to have caused a glitch in the process – which it took 43 minutes for convicted killer Clayton Lockett to die. His death, however, was not caused by the chemicals intended for lethal injection. Instead, according to reports, Lockett’s vein exploded in reaction to the process and, as a result, he died of a heart attack. This execution with new untested chemicals has again raised the cruel and unusual punishment debate, and as part of that debate, the question arises: Should new drugs be tested and approved like the drug combinations used in years past?

Opponents of abandoning the new drugs say these are vicious and terrible criminals who made victims and victims’ friends and family suffer, so they see no problem with using new chemical combinations that may not carry out the execution in an optimal manner. They further say testing, as is it done with other drugs, will cost a lot of money and researchers’ time – time and resources they believe could be spent on other medical endeavors.

Proponents say in some cases few people know what these new chemicals are, or even where they were made. They say using untested combinations of drugs is essentially experimenting on people against their will and the will of U.S. citizens. And in the cases of Locket and McGuire, some claim the executions amounted to torture. They also say because the drug combinations are untested and cause problems with executions, doctors have been distancing themselves from administering the dosages based on ethical concerns. So, fewer and fewer medical personnel are willing to take part in the process.

What’s left are states scrambling and bartering for the last remaining tested drugs used for executions. The rest rely on pharmacies that customize medicine and have fewer restrictive regulations. Some states are even dusting off their electric chairs. Even so, some people think the executions should continue, untested drugs or not, and others think this new approach has gone too far.

Debate Forum Question of the Week:

Has there been sufficient testing on the current drug combination used for lethal injections in the United States, or is further research necessary?

Debate Left: Unmasking the executioner

By Ben Tomkins

In some way, shape or form, all executioners wear a mask. For centuries, the iconic black hood was sufficient for the steadying of the hand when the job was done in the most personal way possible. While it obviously protected the executioner from identification by the masses, should something go wrong or the fluttering breeze of public opinion change, the anonymity it granted its wearer from his own conscience was far more important.

In order to perform his job well, his hand must be swift, strong and unwavering; and when he steps onto the scaffold, the mask grants him a degree of confidence the work will be impersonal. Although there are many, many recorded cases in history of shaking knees and averted eyes turning a swift execution into a debacle, the job would be made far, far more unsteadying should the executioner have to ruminate on the possibility of being identified by his charge.

That burden is borne by the assembled crowd of his fellow citizens who condemn the criminal. The brief moment the accused locks his eyes on each of his accusers is the final appeal to the conviction of their conscience, as each citizen mutely casts the final vote of guilty.

The only party excused from the inquisition is the executioner. The mask of anonymity disallows the convict’s gaze from personalizing the act, and in doing so the blow dealt to his neck is delivered by the collective consciences of each of those who stands unmasked before him. Therefore, the real protection of the mask is transformative. The executioner absolves the crowd of the psychological burden of the act, and the crowd likewise for the physical.

The inborn need for humans in a society that inflicts capital punishment to resolve those two dynamics within themselves is why the framers of our Constitution included within it a prohibition against cruel and unusual punishment. As soon as we allow ourselves the luxury of indulging viciousness, thoughtlessness or indifference while administering justice, the commutative power of the mask vanishes. In that instant, we become guilty ourselves if the ax strays, or, in the case of Clayton Lockett, the drug cocktail fails – because we are responsible for knowingly blunting the tool and indulging that which we impugned in the criminal.

Of course, no one can know for sure if any drug regimen is painless or cruel. By definition, there is no way to check after the fact. However, with research and knowledge of physiology, it is possible to know with enough assurance for states that allow capital punishment we can be reasonably sure we aren’t fooling ourselves for the sake of expedience. As such, we and the person who administers the drugs can sleep at night knowing the life he takes has been done in a way that is tolerable for his conscience and vouchsafed by the raised hands of his fellow citizens.

However, since the European company that produced the critical drug used in lethal injections has ceased production, states like Oklahoma have scrambled to find an alternative that will reasonably satiate the Eighth Amendment. As a result, is has been party to a second torturous execution due to an inadequate study of the administration and effect of the chemicals in question.

The reason the situation has been allowed to exist in the first place is because officials in states using these new protocols seem to feel the physical job of swinging the ax is the sum total of what an execution actually is. They have forgotten the final conviction is not the conclusion of the last appeal, but the moment of the act itself. A convicted person does not become a cow waiting in line on the slaughterhouse floor the moment the final gavel bangs down on the judge’s bench. The gavel is not the mask and the transmutation imparted by the mask is not – nor has it ever been – undergone by the criminal.

We cannot allow ourselves to treat a person being executed as an experiment or a tumor to be excised by whatever means are convenient, cheap or available. They are a human being until they are no longer alive, and we as a society must have the courage to look them in the eyes if we are to expect to be able to grant ourselves the right to pass a death sentence.

Today, it’s made all the more easy to avert our eyes since we don’t live in tiny medieval hamlets where executions are conducted in the town square. When Lockett’s execution took place, I was probably watching a movie and completely unaware it was even happening. Indeed, I would have never known had something not gone horribly wrong. Now I know who he was. I’m writing an opinion about how he died for a newspaper in a state where it didn’t even occur. My wife and I were having a serious conversation about it the morning after when we read the news online. The speed with which the power of the mask evaporates when the sharpness of the blade is questioned is proof positive of the gravity and reality of our deepest connection to a common humanity.

Executions that cannot be performed reliably and humanely must never be allowed to take place, because once we tolerate their performance we remove the mask and grasp the ax ourselves.

Ben Tomkins is a violinist, teacher, journalist, and critically acclaimed composer currently living in Denver, Colo. He hates stupidity, and generally believes that the volume of one’s voice is inversely proportional to one’s knowledge of the issue. Reach Ben Tomkins at BenTomkins@DaytonCityPaper.com.

Debate Right: Lethal injection – a humane death?

By Dave Westbrock

On the subject of the current use of injectable drugs for capital punishment – particularly the recent case of Clayton Lockett, executed in Texas for the murder and live burial of his 19-year-old victim – the hackneyed quote from Benjamin Franklin: “Believe only half of what you see and nothing that you hear” is appropriate.

In this case, skepticism should be leveled at most news reports about the botched execution. Although I am personally conflicted regarding the death penalty, if it is judged to be appropriate, this man and his act are fitting candidates for such penalty. I will analyze the facts from my point of view as a practicing physician of 42 years. I have at one time or another prescribed or administered all of these drugs, particularly during internship and residency, with the goal of sustaining life. In this article, my goal is to look at the facts objectively as to why the execution went wrong without either a pro death penalty bias or one that is uniformly against it.

First, let us look at the means of execution in this case – a combination of drugs that have been around for many years. Thiopental (pentobarbital) is a barbiturate, like phenobarbital which was widely used in the past as an anti-convulsant and sedative. It was widely used in preoperative sedation in years past, as a tranquilizer long before Valium and Ativan. Its safety was dependent on its dosage. It was replaced because modern sedatives had a higher safety profile and were not as long-lasting. Pancuronium bromide (Pavulon), a paralytic agent, is similar to the curare used by some Indian tribes to paralyze their victims, but it is widely used in intensive care units to control muscular activity in patients on ventilators to allow them to breathe easier with assisted ventilation. The third drug in this deadly cocktail is potassium chloride (KCl), used in both oral form chiefly in individuals with potassium wasting due to diuretics, and intravenously dozens of times in every hospital in the world for individuals who need fluid sustenance and replacement. When given intravenously, undiluted in a volume of intravenous fluid, its effects can be fatal – causing ventricular tachycardia and resultant death.

Therefore, in view of the wide use and experience with these drugs, often used together, particularly in hospital settings, why is there a need to study the combination?

Indeed, in doing research, do we use animal models – which, in this situation, would be highly unpredictable? I can guarantee one could find no human volunteers for human research studies, except perhaps in Oregon, a state that sanctions euthanasia.

Several possibilities are pertinent in the case of what went wrong. Was Lockett a drug user prior to his conviction? Although no reports are available to answer the question, it is known habitual users are resistant to the effects of doses of drugs suitable in non-users. It is one reason users become habituated to drugs and need more frequent doses and in higher amounts as their habit continues. Could this have been a factor? Second, there is little doubt that using high doses of each of these drugs can first sedate completely, second paralyze and third cause a fatal cardiac rhythm disturbance with a high enough dose of KCl. Such consequences do not require much study.

Reports vary from his “thrashing violently” to having had a generalized seizure. In the case of the latter, I have never witnessed or even heard of someone being conscious during a grand mal seizure. Additionally, it is said that his vein “exploded.” In countless situations, when an intravenous needle or catheter becomes dislodged from its vein, it infiltrates the fluid designed to go into the venous system and to its target organ, and swells due to fluid in the surrounding tissues. This hardly constitutes an explosion. The fact that it was difficult to catheterize a peripheral vein necessitated the need to use the femoral vein. This is seldom used except in life-threatening circumstances to deliver intravenous fluids, but can be safely used to obtain venous blood when a peripheral vein cannot be accessed. Therein lies the real issue. Since a femoral vein is not possible to feel, one finds it by locating the femoral artery and placing the needle just inside the palpable artery. This was apparently the “botch,” and likely resulted in failure to deliver the drugs in adequate doses, since an indeterminate amount was delivered to the surrounding tissues. Therefore, less than adequate amounts of drugs were able to completely sedate, then completely paralyze. However, there was not enough KCl delivered to the heart to quickly stop the heartbeat. Instead, the result was a cardiac dysrhythmia.

Down through history, do we suppose no other means of execution had adverse consequence? Did no firing squad in history find it necessary to reload and fire again? Was it never seen that a rope broke in the act of carrying out an execution by hanging? Remember “old sparky,” the Florida electric chair, the use of which was eventually banned because an occasional candidate caught fire? It seems that the gas chamber also had its problems. Agree or not with capital punishment, lethal injection is the most humane method of execution yet devised.

Dr. Westbrock has been in private medical practice for 35 years. He was the Republican candidate for the U.S House of Representatives in 1994 and 1996. He has written and lectured extensively on the subject of health care reform and health care policy. He can be reached at Dave.Westbrock@DaytonCityPaper.com.